Bladder Repair

Minimally Invasive Bladder Repair for Stress Urinary Incontinence

Minimally invasive surgical procedures are often used to treat the most common type of incontinence, stress urinary incontinence (SUI). This condition often results from inadequate bladder support from the pelvic muscles or a weak or damaged urethra. Two methods offered at the University of Maryland are the Tension Free Vaginal Tape (TVT) and the TVT Obturator System (TVTO).

Below are answers to common questions about urinary incontinence and treatments:

What is stress urinary incontinence? (SUI)

Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise. You may also have SUI if you lose urine when you walk, lift something, or get up from a seated or lying position.

Any movement that puts pressure on the bladder (such as a sneeze) causes the urethra to lose its seal and allows urine to escape.

What causes SUI?

Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra, or because of malfunction of the urethral sphincter. Prior trauma to the urethral area, neurological injury, and some medications may weaken the urethra.

What minimally invasive treatments are offered at the University of Maryland?

Two methods offered are the Tension Free Vaginal Tape (TVT) and the TVT Obturator System (TVTO).

Tension Free Vaginal Tape is a minimally invasive surgical procedure, appropriate for some women with stress urinary incontinence. During this procedure, a sling is created using a synthetic mesh ribbon-like strip that is surgically inserted through the vagina and placed under the urethra to keep it in its normal position. This allows urethra to remain closed, preventing the involuntary release of urine. Placing the support at the middle of the urethra (as opposed to a position closer to the bladder, as in traditional sling procedures) more closely simulates natural support at a crucial pressure point, and helps to maintain the urethra in its proper position.

The procedure can be performed under local anesthesia and takes only about half an hour to complete. The recovery period following the procedure is short, and patients experience few complications and minimal scarring after surgery.

The TVT Obturator System Tension-Free Support for Incontinence, a novel surgical device for treatment of female stress urinary incontinence (SUI), adds the safety and convenience of the obturator approach, and further optimizes safety with a unique "inside-out" approach.

The GYNECARE® TVT Obturator System "inside-out" technique passes the mesh device from a small incision in the vagina out to small incisions in the thigh folds. This passage away from the urethra and bladder avoids the retropubic space and therefore reduces the potential for urethral and bladder injury. Like TVT, the TVT Obturator System uses the same PROLENE® polypropylene mesh used in more than 500,000 SUI procedures worldwide and proven safe and effective with seven years of clinical data.

Based on your surgical history and symptoms, your doctor may also consider a traditional suburethral sling to treat stress urinary incontinence. The sling procedure uses a small strip of the patient's own fascial tissue to support the urethra in a more anatomic position.

What are the advantages of TVT and TVTO?

They are used in simple procedures that can be completed within 30 minutes

Procedure offers a quick recovery time and minimal pain--patients can resume normal activities with a couple of days.

Most patients will not require catheterization.

Procedure can be performed under local anesthesia in an outpatient setting

Products are evaluated for success during the procedure. The surgeon asks the patient to cough, and then evaluates whether the tape is providing adequate support and makes any necessary adjustments before leaving the operating room.

The most advanced technologies and a variety of treatments assure comprehensive and integrated care for these pelvic disorders. University of Maryland urogynecologists use computerized urodynamic testing and cystoscopy in addition to targeted physical examinations to more precisely pinpoint the cause of the disorder.

Finally, the University of Maryland is one of nine academic medical centers which comprise the Urinary Incontinence Treatment Network (UITN), sponsored by the National Institutes of Health (NIH). The UITN was established in July 2000 to study urinary incontinence in women. We are actively involved in research with the NIH to identify treatments for incontinence and offer the latest techniques to those who participate.

For more information or to make an appointment, please call 1-866-608-4228.